Having a Primary Care Physician: Individual and Community Characteristics in Japan

Ryosuke Sugiura; Yasuharu Tokuda; Gautam Deshpande; Cathy J. Bradley; Sachiko Ohde; Takahiro Tabuchi

doi:10.56741/IISTR.jphs.002178

Authors

Ryosuke Sugiura University of Tsukuba https://orcid.org/0000-0003-4175-4987
Yasuharu Tokuda
yasuharu.tokuda@gmail.com
Muribushi Okinawa Center for Teaching Hospitals https://orcid.org/0000-0002-9325-7934
Gautam Deshpande Juntendo University https://orcid.org/0000-0002-0293-8911
Cathy J. Bradley Colorado School of Public Health https://orcid.org/0000-0001-9429-6567
Sachiko Ohde St. Luke’s International University https://orcid.org/0000-0001-9137-0047
Takahiro Tabuchi Tohoku University https://orcid.org/0000-0002-1050-3125

Keywords:

Cross-Sectional Survey, Gender Difference, Health Behavior, Living Environment, Primary Health Care

Abstract

Primary care is vital for disease prevention, but factors influencing access to primary care physicians (PCPs) in Japan are not well understood. Using data from 28,481 respondents in the 2023 JACSIS survey, we analyzed demographic, health, and community characteristics associated with having a PCP. The proportion of individuals with a PCP was lowest in the early thirties and increased with age. Employment demands, child-rearing responsibilities, living alone, and weak community ties were Primary care is vital for disease prevention, but factors influencing access to primary care physicians (PCPs) in Japan are not well understood. Using data from 28,481 respondents in the 2023 JACSIS survey, we analyzed demographic, health, and community characteristics associated with having a PCP. The proportion of individuals with a PCP was lowest in the early thirties and increased with age. Employment demands, child-rearing responsibilities, living alone, and weak community ties were associated with a lower likelihood of having a PCP, while older age, chronic conditions, health-conscious behaviors, and strong community relationships increased PCP access. Mental health issues and a history of drug use were associated with lower PCP proportions. Our findings suggest that improving PCP access in vulnerable groups requires attention to health literacy, time availability, and community support, rather than focusing solely on income or education. Targeted efforts may help increase PCP utilization among those most in need.associated with lower likelihood of having a PCP, while older age, chronic conditions, health-conscious behaviors, and strong community relationships increased PCP access. Mental health issues and a history of drug use were associated with lower PCP proportions. Our findings suggest that improving PCP access in vulnerable groups requires attention to health literacy, time availability, and community support, rather than focusing solely on income or education. Targeted efforts may help increase PCP utilization among those most in need.

Downloads

Download data is not yet available.

Author Biographies

Ryosuke Sugiura, University of Tsukuba

is affiliated with the College of Medicine, University of Tsukuba, Japan. His academic interests include clinical medicine, public health, epidemiology, and population-based health research. His research activities focus on understanding health outcomes and factors affecting population health through clinical and epidemiological perspectives. He is also interested in evidence-based approaches to improving healthcare delivery and health outcomes across diverse populations. (email: sugiura.ryosuke.qm@alumni.tsukuba.ac.jp).

Yasuharu Tokuda, Muribushi Okinawa Center for Teaching Hospitals

is affiliated with the Muribushi Okinawa Center for Teaching Hospitals, Japan. His academic and professional interests include general internal medicine, clinical epidemiology, medical education, and healthcare quality. He has been actively involved in clinical research and physician education, with particular attention to evidence-based medicine, diagnostic reasoning, and improving the quality and effectiveness of healthcare services in clinical settings. (email: Yasuharu.tokuda@gmail.com).

Gautam Deshpande, Juntendo University

is affiliated with the Department of International Healthcare, Juntendo University Hospital, Japan. His professional and research interests include international healthcare, clinical medicine, global health, and cross-cultural healthcare delivery. His academic activities emphasize improving healthcare practices across diverse populations and strengthening international perspectives in clinical research, healthcare systems, and medical education through interdisciplinary and collaborative approaches to global health challenges. (email: drdeshpande@gmail.com).

Cathy J. Bradley, Colorado School of Public Health

is affiliated with the Colorado School of Public Health, USA. Her research interests include health economics, cancer outcomes, health policy, and population health. Her scholarly work examines the economic and social consequences of cancer, healthcare access, employment, and health disparities. She has contributed extensively to understanding how healthcare systems and socioeconomic factors influence outcomes among individuals affected by cancer. (email: cathy.bradley@cuanschutz.edu).

Sachiko Ohde, St. Luke’s International University

is affiliated with Graduate School of Public Health, St. Luke’s International University, Japan ORCID: ). Sachiko Ohde is affiliated with the Graduate School of Public Health, St. Luke’s International University, Japan. Her academic interests include public health, epidemiology, clinical research, and healthcare quality. Her research focuses on evaluating health outcomes and healthcare practices using epidemiological approaches. She is also involved in education and research aimed at strengthening evidence-based healthcare and improving the quality of health services and population health. (email: saohde@slcn.ac.jp).

Takahiro Tabuchi, Tohoku University

is affiliated with the Division of Epidemiology, Tohoku University, Japan. His research interests include epidemiology, public health, health behavior, and population-based research. His scholarly work examines behavioral and social determinants of health using large-scale epidemiological data. He has contributed to research addressing tobacco control, health disparities, and other major public health challenges relevant to population health and preventive health policy. (email: tabuchitak@gmail.com).

References

B. Starfield, L. Shi, and J. Macinko, “Contribution of primary care to health systems and health,” Milbank Q., vol. 83, no. 3, pp. 457–502, 2005, doi: 10.1111/j.1468-0009.2005.00409.x. DOI: https://doi.org/10.1111/j.1468-0009.2005.00409.x

D. Yokokawa, Y. Ohira, A. Ikegami, et al., “Relationship between the presence of primary care physicians and health-related quality of life,” J. Gen. Fam. Med., vol. 23, no. 2, pp. 87–93, 2021, doi: 10.1002/jgf2.490. DOI: https://doi.org/10.1002/jgf2.490

Japan Primary Care Association, “Specialist and Certified Physician Certification Regulations,” Art. 1, rev. Oct. 5, 2025. [Online]. Available: https://www.primary-care.or.jp/file/pdf_file.php?file=senmonininteiyouko. Accessed: Jun. 26, 2026.

T. Aoki and M. Matsushima, “Factors associated with the status of usual source of care during the COVID-19 pandemic: A nationwide survey in Japan,” BMC Prim. Care, vol. 24, p. 193, 2023, doi: 10.1186/s12875-023-02148-9. DOI: https://doi.org/10.1186/s12875-023-02148-9

J. W. He, A. L. Terry, D. Lizotte, G. Bauer, and B. L. Ryan, “Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy,” PLoS One, vol. 19, no. 1, e0296657, 2024, doi: 10.1371/journal.pone.0296657. DOI: https://doi.org/10.1371/journal.pone.0296657

D. Kato, H. Ryu, T. Matsumoto, et al., “Building primary care in Japan: Literature review,” J. Gen. Fam. Med., vol. 20, no. 5, pp. 170–179, 2019, doi: 10.1002/jgf2.252. DOI: https://doi.org/10.1002/jgf2.252

H. Someko, K. Anan, T. Tabuchi, et al., “Data Resource Profile: The Japan COVID-19 and Society Internet Survey (JACSIS),” Int. J. Epidemiol., vol. 55, no. 2, dyag025, 2026, doi: 10.1093/ije/dyag025. DOI: https://doi.org/10.1093/ije/dyag025

T. Tabuchi, T. Shinozaki, N. Kunugita, M. Nakamura, and I. Tsuji, “Study Profile: The Japan ‘Society and New Tobacco’ Internet Survey (JASTIS): A longitudinal internet cohort study of heat-not-burn tobacco products, electronic cigarettes, and conventional tobacco products in Japan,” J. Epidemiol., vol. 29, no. 11, pp. 444–450, 2019, doi: 10.2188/jea.JE20180116. DOI: https://doi.org/10.2188/jea.JE20180116

J. J. Prochaska, H. Y. Sung, W. Max, Y. Shi, and M. Ong, “Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization,” Int. J. Methods Psychiatr. Res., vol. 21, no. 2, pp. 88–97, 2012, doi: 10.1002/mpr.1349. DOI: https://doi.org/10.1002/mpr.1349

T. A. Furukawa, N. Kawakami, M. Saitoh, et al., “The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan,” Int. J. Methods Psychiatr. Res., vol. 17, no. 3, pp. 152–158, 2008, doi: 10.1002/mpr.257. DOI: https://doi.org/10.1002/mpr.257

K. Tomioka, J. Iwamoto, K. Saeki, and N. Okamoto, “Reliability and validity of the International Physical Activity Questionnaire (IPAQ) in elderly adults: The Fujiwara-kyo Study,” J. Epidemiol., vol. 21, no. 6, pp. 459–465, 2011, doi: 10.2188/jea.JE20110003. DOI: https://doi.org/10.2188/jea.JE20110003

Ministry of Health, Labour and Welfare, “Measures to address uneven distribution of doctors through doctor recruitment plans.” [Online]. Available: https://www.mhlw.go.jp/content/000700132.pdf. Accessed: May 6, 2025.

T. Tabuchi, S. Gallus, T. Shinozaki, T. Nakaya, N. Kunugita, and B. Colwell, “Heat-not-burn tobacco product use in Japan: Its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol,” Tob. Control, vol. 27, no. e1, pp. e25–e33, 2018, doi: 10.1136/tobaccocontrol-2017-053947. DOI: https://doi.org/10.1136/tobaccocontrol-2017-053947

E. A. Kaufman, M. G. McDonell, M. A. Cristofalo, and R. K. Ries, “Exploring barriers to primary care for patients with severe mental illness: Frontline patient and provider accounts,” Issues Ment. Health Nurs., vol. 33, no. 3, pp. 172–180, 2012, doi: 10.3109/01612840.2011.638415. DOI: https://doi.org/10.3109/01612840.2011.638415

H. C. Hahm and S. P. Segal, “Failure to seek health care among the mentally ill,” Am. J. Orthopsychiatry, vol. 75, no. 1, pp. 54–62, 2005, doi: 10.1037/0002-9432.75.1.54. DOI: https://doi.org/10.1037/0002-9432.75.1.54

M. L. Radell, E. G. A. Hamza, W. H. Daghustani, A. Perveen, and A. A. Moustafa, “The impact of different types of abuse on depression,” Depress. Res. Treat., vol. 2021, 6654503, 2021, doi: 10.1155/2021/6654503. DOI: https://doi.org/10.1155/2021/6654503

I. Ganguli, T. H. Lee, and A. Mehrotra, “Evidence and implications behind a national decline in primary care visits,” J. Gen. Intern. Med., vol. 34, no. 10, pp. 2260–2263, 2019, doi: 10.1007/s11606-019-05104-5. DOI: https://doi.org/10.1007/s11606-019-05104-5

E. Kobayashi, K. Nonaka, M. Kuraoka, et al., “Community child-rearing support scale: Applicability across generations and differences in the supportive behaviors among generations,” Nihon Koshu Eisei Zasshi, vol. 65, pp. 321–333, 2018, doi: 10.11236/jph.65.7_321.

H. E. Alcalá, A. Valdez-Dadia, and O. S. von Ehrenstein, “Adverse childhood experiences and access and utilization of health care,” J. Public Health (Oxf.), vol. 40, no. 4, pp. 684–692, 2018, doi: 10.1093/pubmed/fdx155. DOI: https://doi.org/10.1093/pubmed/fdx155

X. Xie, Y. Lyu, X. Li, Z. Zhuang, and A. Xu, “Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China,” Front. Public Health, vol. 12, 1341304, 2024, doi: 10.3389/fpubh.2024.1341304. DOI: https://doi.org/10.3389/fpubh.2024.1341304

H. Murayama, T. Suda, I. Nakamoto, T. Shinozaki, and T. Tabuchi, “Changes in social isolation and loneliness prevalence during the COVID-19 pandemic in Japan: The JACSIS 2020–2021 study,” Front. Public Health, vol. 11, 1094340, 2023, doi: 10.3389/fpubh.2023.1094340. DOI: https://doi.org/10.3389/fpubh.2023.1094340

D. B. Fell, G. Kephart, L. J. Curtis, et al., “The relationship between work hours and utilization of general practitioners in four Canadian provinces,” Health Serv. Res., vol. 42, no. 4, pp. 1483–1498, 2007, doi: 10.1111/j.1475-6773.2006.00683.x. DOI: https://doi.org/10.1111/j.1475-6773.2006.00683.x

J. C. Prentice, “Neighborhood effects on primary care access in Los Angeles,” Soc. Sci. Med., vol. 62, no. 5, pp. 1291–1303, 2006, doi: 10.1016/j.socscimed.2005.07.029. DOI: https://doi.org/10.1016/j.socscimed.2005.07.029

P. Yuen and R. Balarajan, “Unemployment and patterns of consultation with the general practitioner,” BMJ, vol. 298, no. 6682, pp. 1212–1214, 1989, doi: 10.1136/bmj.298.6682.1212. DOI: https://doi.org/10.1136/bmj.298.6682.1212

M. McArthur, P. Tian, K. A. Kho, K. P. Bhavan, B. A. Balasubramanian, and A. P. Ganguly, “Childcare as a social determinant of access to healthcare: A scoping review,” Front. Public Health, vol. 12, 1443992, 2024, doi: 10.3389/fpubh.2024.1443992. DOI: https://doi.org/10.3389/fpubh.2024.1443992

M. E. Heffernan, N. L. Alfieri, A. Keese, et al., “Differences in responsibility for child healthcare by parent gender: A cross-sectional study,” Soc. Sci. Med., vol. 365, 117576, 2025, doi: 10.1016/j.socscimed.2024.117576. DOI: https://doi.org/10.1016/j.socscimed.2024.117576

Y. Shirakura, Y. Shobugawa, and R. Saito, “Geographic variation in inpatient medical expenditure among older adults aged 75 years and above in Japan: a three-level multilevel analysis of nationwide data,” Front. Public Health, vol. 12, 1306013, 2024, doi: 10.3389/fpubh.2024.1306013. DOI: https://doi.org/10.3389/fpubh.2024.1306013

V. Baccolini, C. Isonne, C. Salerno, et al., “The association between adherence to cancer screening programs and health literacy: A systematic review and meta-analysis,” Prev. Med., vol. 155, 106927, 2022, doi: 10.1016/j.ypmed.2021.106927. DOI: https://doi.org/10.1016/j.ypmed.2021.106927

A. Oberne, C. Vamos, L. Wright, W. Wang, and E. Daley, “Does health literacy affect fruit and vegetable consumption?” J. Am. Coll. Health, vol. 70, no. 1, pp. 134–141, 2022, doi: 10.1080/07448481.2020.1727911. DOI: https://doi.org/10.1080/07448481.2020.1727911

K. Rudolf, B. Biallas, L. A. L. Dejonghe, et al., “Influence of health literacy on the physical activity of working adults: A cross-sectional analysis of the TRISEARCH Trial,” Int. J. Environ. Res. Public Health, vol. 16, no. 24, 4948, 2019, doi: 10.3390/ijerph16244948. DOI: https://doi.org/10.3390/ijerph16244948

T. Aoki and M. Inoue, “Association between health literacy and patient experience of primary care attributes: A cross-sectional study in Japan,” PLoS One, vol. 12, no. 9, e0184565, 2017, doi: 10.1371/journal.pone.0184565. DOI: https://doi.org/10.1371/journal.pone.0184565

M. Lamot and A. Kirbis, “Understanding vaccine hesitancy: A comparison of sociodemographic and socioeconomic predictors with health literacy dimensions,” Vaccines (Basel), vol. 12, 1141, 2024, doi: 10.3390/vaccines12101141. DOI: https://doi.org/10.3390/vaccines12101141

H. Zhang, Y. Li, S. Peng, Y. Jiang, H. Jin, and F. Zhang, “The effect of health literacy on COVID-19 vaccine hesitancy among community population in China: The moderating role of stress,” Vaccine, vol. 40, pp. 4473–4478, 2022, doi: 10.1016/j.vaccine.2022.06.015. DOI: https://doi.org/10.1016/j.vaccine.2022.06.015

A. Hajek, A. R. Sutin, A. Terracciano, et al., “Ikigai and use of preventive healthcare services in Germany,” Prev. Med., vol. 189, 108159, 2024, doi: 10.1016/j.ypmed.2024.108159. DOI: https://doi.org/10.1016/j.ypmed.2024.108159

H. Saito, A. K. Abubakar, A. Ozaki, et al., “Colorectal cancer screening amid COVID-19 in Japan: analysis from the 2021–2022 JACSIS study,” Cancer Med., 2025, doi: 10.1002/cam4.70859. DOI: https://doi.org/10.1002/cam4.70859